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The Dream Catcher

Fred Darrow, an Anglo clinical psychologist and a provider affiliated with a state mental health agency, is engaged in therapy with a Navajo client, Selena House, in Farmington, New Mexico. Upon the completion of services, Selena offers Fred a dream catcher made of bird feathers as a symbol of the mutual shared association that the two have enjoyed. It is intended as a personal token commemorating the professional relationship between Selena and Fred, and has no ostensible monetary value. She makes an additional gift to Fred of artwork she has completed that arguably has at least some monetary value. Fred’s practice decisions in this scenario involve his handling of the gifts and his communications to the client regarding the gifts.

Following the framework, Fred explores the law applicable to this scenario, thoughtfully examining whether regional variations might influence his application of law to the present scenario. Fred finds no applicable law that would rule out acceptance of the dream catcher, but does find state law that forbids the acceptance of gifts with an appreciable monetary value. Fred decides fairly quickly that the law is not an impediment to his acceptance of the dream catcher, and that in view of the relevant cultural traditions of his client, acceptance of the gift would be both appropriate and in Selena’s best therapeutic interests. On the other hand, Fred is satisfied that acceptance of the art work would violate law forbidding the acceptance of gifts by state employees.

Fred is next inspired to review the APA Code in order to evaluate whether its principles support his initial legal analysis. Reviewing applicable ethical standards, Fred is particularly interested in determining whether it is ethical in any circumstance to accept gifts from a client. Because gift-giving by clients runs the hazard of creating a social relationship with a client, Fred seeks out APA Ethical Standard 3.05a, which sets forth guidelines concerning multiple relationships. Specifically, the standard suggests that psychologists should avoid relationships that could reasonably be expected to impair the psychologist's objectivity or competence, or risks exploitation or harm to the person with whom the professional relationship exists. Interestingly, the same standard acknowledges that some multiple relationships simply may not be harmful: As the Standard puts it, “Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.” Fred finds APA Ethical Standard 3.08, governing exploitation of clients, to be equally applicable. It admonishes simply that “psychologists do not exploit … clients/patients.”

These ethical standards’ overt ambiguity seems to offer some leeway to psychologists to evaluate the cultural and regional context of their social relationship with a client. Additionally, the ethical standards’ ambiguity renders them virtually meaningless without a thorough review of community and cultural norms governing the scenario. This point is further supported by the APA’s Ethical Standard 2.01b, which suggests that among other competencies, psychologists should display cultural awareness of their clients.

Consistent with the framework, Fred next proceeds to review the cultural context of the gifts conferred by the client, with a specific emphasis on evaluating the risk of harm or exploitation inherent in this transaction. Such a review naturally requires that Fred be versed in the cultural meaning of the exchange and, if conducted fully, is likely to acquaint Fred with the cultural and spiritual meanings conferred by gift-giving and sharing in general within American Indian communities. It might further suggest to him that it could be more harmful to the client to reject these gifts than to accept them. The framework’s cultural component therefore assists in the interpretation of legal and ethical standards that impact the dilemma. The result suggested by this approach, namely that the psychologist acts appropriately if he accepts the dream catcher, is consistent both with cultural competence and clinically advisable practice. Moreover, the legal restriction placed upon Fred’s acceptance of the artwork arguably requires Fred to engage all of his clinical knowledge and sensitivity in explaining his stance to Selena.

In addition to considering cultural and regional norms, Fred might be likely to integrate his own clinical training and ideological perspectives in his resolution of the practice dilemma. Consistent with the communitarian stance, this consideration is most usefully undertaken only after the decision maker has objectively explored the cultural context of the client’s gifts. This strategy is appropriate in the resolution of other practice dilemmas that require the decision maker to interpret legal and ethical standards.